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OBJECTIVE: Otitis media and associated otorrhea are frequent complications following tympanostomy tube insertion; the most common otologic procedure performed in children in the United States. Current treatments include the administration of antibiotic or antibiotic/anti-inflammatory combination drops to the affected ear. Several studies have demonstrated that using an antibiotic/anti-inflammatory combination product is more effective than the use of antibiotics alone. However, administration of any drops through the tympanostomy tube is very difficult in children, and patient compliance can be an issue. Our group has developed a novel combination drug/hydrogel formulation for the treatment of otitis media/otorrhea that releases both ciprofloxacin and dexamethasone over a 2-3 week period. This has the potential to offer significant advantages over current treatments in use in the clinic. METHODS: The release of drugs from the combination hydrogel was validated in vitro over the desired time frame and the activity of the released drugs was monitored via assays to confirm retention of full activity throughout the dissolution period. The safety of the ciprofloxacin/dexamethasone hydrogel and its inactive excipients was evaluated through in vivo otic toxicity studies in guinea pigs, including hearing tests, gross microscopy, and cytocochleogram analysis. RESULTS: Extended release of both drugs was demonstrated in vitro and antibiotic/anti-inflammatory activities were retained. The hydrogel components and its excipients did not cause adverse reactions in animals, demonstrating safety of the hydrogel combination in vivo. CONCLUSION: The studies presented lay the groundwork for extended release middle ear hydrogel formulations that are capable of safely releasing combinations of active pharmaceutical agents over a desired period of time. This would be more advantageous than therapeutics that are currently used in the clinic for the treatment of otitis media/otorrhea associated with tympanostomy tube insertion.

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OBJECTIVE: Cisplatin is a chemotherapeutic drug known to induce hearing loss. Although corticosteroids may help to mitigate the ototoxic side effects of cisplatin, there are complications associated with their systemic and prolonged use. The goal of this study is to test the efficacy of extended-release fluticasone propionate intracochlear implant particles to protect against cisplatin-induced hearing loss. METHODS: We used guinea pigs (n = 9) injected with cisplatin (IP, 12 mg/kg weight). Fluticasone particles were delivered to the cochlear scala tympani through the round window membrane into the right ears of the guinea pigs (left ears being used as a control) two weeks prior to cisplatin administration, and hearing function was evaluated by ABR and DPOAE before implantation, immediately before cisplatin administration, and 2 weeks after the challenge with cisplatin. Data was statistically evaluated using paired t-test analysis. RESULTS: No significant differences were observed in ABR threshold between control and implanted ears on day 14 (23.9 ±â€¯2.3 dB vs. 25.6 ±â€¯1.3 dB, P = 0.524), whereas the significant cisplatin-induced hearing loss in control animals (23.9 ±â€¯2.3 dB at day 14 vs. 40.7 ±â€¯2.5 dB at day 28, P ≤ 0.0001) was prevented in implanted animals (25.6 ±â€¯1.3 dB at day 14 vs. 25.0 ±â€¯3.1 at day 28, P ≥ 0.85). A similar, though not statistically significant, trend was observed in DPOAE responses in untreated ears (7.9 ±â€¯5.8 dB at day14 vs. -0.5 ±â€¯5.3 dB at day 28, P = 0.654) as compared to treatment (11.1 ±â€¯3.4 dB at day 14 vs. 13.6 ±â€¯4.8 dB at day 28, P = 0.733). CONCLUSION: These results suggest that fluticasone intracochlear implants are safe and able to provide effective otoprotection against cisplatin-induced hearing loss in the guinea pig model.

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OBJECTIVE: Investigate a new polymer-based drug coating suitability for safe intracochlear delivery and ability to maintain long-term physiologically active levels of the corticosteroid fluticasone propionate. STUDY DESIGN: In vitro dissolution study to evaluate release profiles of polymer-coated drug particles and in vivo studies using a guinea pig model to measure perilymph drug concentrations at specific time points after implantation with polymer-coated drug particles and evaluate their effect on hearing function. METHODS: Polymer-coated fluticasone propionate (FP) particles were surgically implanted in guinea pigs through the round window membrane into the cochlear scala tympani. In the pilot study, pre- and post-op hearing thresholds were conducted on days 7, 14, and 42. In a second study, post-op hearing thresholds were conducted on days 90, 120, and 180. Perilymph drug concentrations were measured on the same time points. RESULTS: In 15 of 16 animals from day 7 through day 90, drug levels were within the targeted range, with no initial burst release detected. Drug was present in all animals on day 90 and was detected in some animals at 120 and 180 days. Hearing was tested and compared with non-implanted ears. Very good hearing preservation was observed in ears implanted with intracochlear particles when compared with contralateral ears. CONCLUSIONS: The polymer-based extended release system is effective in providing long-term, stable drug delivery for at least 90 days with good hearing outcomes. The results of this study support the potential for achieving long-term drug delivery with a single intracochlear administration.

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The importance of drug delivery has increased over the past decades, and significant advances have been made in the development of novel technologies. This review focuses on the use of different polymer drug delivery systems and their advancement toward clinical applications.

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A broad array of water-insoluble compounds has displayed therapeutically relevant properties toward a spectrum of medical and physiological disorders, including cancer and inflammation. However, the continued search for scalable, facile, and biocompatible routes toward mediating the dispersal of these compounds in water has limited their widespread application in medicine. Here we demonstrate a platform approach of water-dispersible, nanodiamond cluster-mediated interactions with several therapeutics to enhance their suspension in water with preserved functionality, thereby enabling novel treatment paradigms that were previously unrealized. These therapeutics include Purvalanol A, a highly promising compound for hepatocarcinoma (liver cancer) treatment, 4-hydroxytamoxifen (4-OHT), an emerging drug for the treatment of breast cancer, as well as dexamethasone, a clinically relevant anti-inflammatory that has addressed an entire spectrum of diseases that span complications from blood and brain cancers to rheumatic and renal disorders. Given the scalability of nanodiamond processing and functionalization, this novel approach serves as a facile, broadly impacting and significant route to translate water-insoluble compounds toward treatment-relevant scenarios.

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Parylene is a biologically inert material capable of being deposited in conformal nanoscale layers on virtually any surface, making it a viable structural material for the fabrication of drug delivery devices, as well as implant coatings, sensors, and other biomedical technologies. Here we explore its novel drug delivery applications by using parylene to package the polymethyloxazoline-polydimethylsiloxane-polymethyloxazoline (PMOXA-PDMS-PMOXA) block copolymer membrane of a nanoscale thickness (approximately 4 nm/layer) mixed with a therapeutic element, creating an active parylene-encapsulated copolymeric (APC) membrane for slow release drug delivery of dexamethasone (Dex), a potent anti-inflammatory and immunosuppressant synthetic glucocorticoid. Given current needs for localized therapeutic release for conditions such as cancer, post-surgical inflammation, wound healing, regenerative medicine, to name a few, this stand-alone and minimally invasive implantable technology may impact a broad range of medical scenarios. To evaluate the applicability of the APC membrane as a biocompatible drug delivery system, real-time polymerase chain reaction (RT-PCR) was performed to investigate the expression of cytokines that regulate cellular stress and inflammation as a result of in vitro RAW264.7 macrophage cell growth on the APC membrane. Significant decreases in relative mRNA levels of IL-6, TNF-alpha, and iNOS were observed. Dex functionalized APC membranes were further found to effectively slow-elute the drug via confocal microscopy, with a confirmed extended elution capability over a period of several days, undergoing phosphate buffered saline washes between time points. In addition, we examined the membrane surface through atomic force microscopy (AFM) to examine Dex/copolymer deposition, and to characterize the surface of the APC membrane. Furthermore, we evaluated the effects of incubation with the APC membrane in solution on macrophage growth behavior and cellular adhesion, including the physical properties of parylene and the copolymer to elucidate the anti-adhesive responses we observed. The results of this study will provide insight into ultra-thin and flexible devices of parylene-encapsulated copolymer membranes as platform drug delivery technologies capable of localized and precision therapeutic drug elution.

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Developing biocompatible polymeric platforms for drug delivery with enhanced localized activity represents a key facet of advanced interventional therapy. In this work, the drug-eluting potential of an amine-functionalized poly- p-xylene commonly known as Parylene A (4-amino(2,2)paracyclophane) was conducted with the microfilm device consisting of a primary base layer, drug film, and a secondary eluting layer presenting exposed amine groups which enhance the range of modifications that can be incorporated into the film. The murine macrophage cell line RAW 264.7 served as a cellular response to dexamethasone, a synthetic anti-inflammatory glucocorticoid and doxorubicin, an anticancer therapeutic. Decreased expression of NFkappa-B-mediated cytokines Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNFalpha), resultant DNA fragmentation, and spectroscopic analysis revealed the efficient and localized drug-eluting properties of the Parylene A polymeric bilayer.

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The release of therapeutic drugs from the surface of implantable devices is instrumental for the reduction of medical costs and toxicity associated with systemic administration. In this study we demonstrate the triblock copolymer-mediated deposition and release of multiple therapeutics from a single thin film at the air-water interface via Langmuir-Blodgett deposition. The dual drug elution of dexamethasone (Dex) and doxorubicin hydrochloride (Dox) from the thin film is measured by response in the RAW 264.7 murine macrophage cell line. The integrated hydrophilic and hydrophobic components of the polymer structure allows for the creation of hybrids of the copolymer and the hydrophobic Dex and the hydrophilic Dox. Confirmation of drug release and functionality was demonstrated via suppression of the interleukin 6 (IL-6) and tumor necrosis factor alpha (TNFalpha) inflammatory cytokines (Dex), as well as TUNEL staining and DNA fragmentation analysis (Dox). The inherent biocompatibility of the copolymeric material is further demonstrated by the lack of inflammation and apoptosis induction in cells grown on the copolymer films. Thus a layer-by-layer anchored deposition of an anti-inflammatory and chemotherapeutic functionalized copolymer film is able to localize drug dosage to the surface of a medical device, all with an innate material thickness of 4 nm per layer.

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Nanodiamonds (NDs) of 2-8 nm diameters physically bound with the chemotherapeutic agent doxorubicin hydrochloride (DOX) were embedded within a parylene C polymer microfilm through a facile and scalable process. The microfilm architecture consists of DOX-ND conjugates sandwiched between a base and thin variable layer of parylene C which allows for modulation of release. Successive layers of parylene and the DOX-ND conjugates were characterized through atomic force microscopy (AFM) images and drug release assays. Elution rates were tested separately over a period of 8 days and up to one month in order to illustrate the release characteristics of the microfilms. The microfilms displayed the stable and continuous slow-release of drug for at least one month due to the powerful sequestration abilities of the DOX-ND complex and the release-modulating nature of the thin parylene layer. Since the fabrication process is devoid of any destructive steps, the DOX-ND conjugates are unaffected and unaltered. A DNA fragmentation assay was performed to illustrate this retained activity of DOX under biological conditions. Specifically, in this work we have conferred the ability to tangibly manipulate the NDs in a polymer-packaged microfilm format for directed placement over diseased areas. By harnessing the innate ND benefits in a biostable patch platform, extended targeted and controlled release, possibly relevant toward conditions such as cancer, viral infection, and inflammation, where complementary alternatives to systemic drug release enabled by the microfilm devices, can allow for enhanced treatment efficacy.

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Nanomaterials such as block copolymeric membranes provide a platform for both cellular interrogation and biological mimicry. Their biomimetic properties are based upon the innate possession of hydrophilic and hydrophobic units that enable their integration with a broad range of therapeutic materials. As such, they can be engineered for specific applications in nanomedicine, including controlled/localized drug delivery. Here we describe a method for the functionalization of the polymethyloxazoline-polydimethylsiloxane-polymethyloxazoline (PMOXA-PDMS-PMOXA) block copolymer with anti-inflammatory molecules to develop copolymer-therapeutic hybrids, effectively conferring biological functionality to a versatile synthetic nanomembrane matrix and creating a platform for an anti-inflammatory drug delivery system. Utilizing self-assembly and Langmuir-Blodgett deposition methods, we mixed copolymers with dexamethasone (Dex), an anti-inflammatory glucocorticoid receptor agonist. The successful mixing of the copolymer with the drug was confirmed by surface pressure isotherms and fluorescence microscopy. Furthermore, at 4 nm thick per layer, orders of magnitude thinner than conventional drug delivery coatings, these dexamethasone-copolymer mixtures (PolyDex) suppressed in vitro expression of the inflammatory cytokines/signaling elements interleukin 6 (IL-6), interleukin 12 (IL-12), tumor necrosis factor alpha (TNFalpha), inducible nitric oxide synthase (iNOS), and interferon gamma inducible protein (IP-10). Finally, PolyDex maintained its anti-inflammatory properties in vivo confirmed through punch biopsies with tissue imagery via hematoxylin/eosin and macrophage specific staining using CD11b. Thus, we demonstrated that PolyDex may be utilized as a localized, highly efficient drug-copolymer composite for active therapeutic delivery to confer anti-inflammatory protection or as a platform material for broad drug elution capabilities.

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Aqueous dispersible detonation nanodiamonds (NDs) with a diameter of 2-8 nm were assembled into a closely packed ND multilayer nanofilm with positively charged poly-L-lysine via the layer-by-layer deposition technique. The innate biocompatibility of the NDs in both free-floating and thin-film forms was confirmed via cellular gene expression examination by real-time polymerase chain reaction as well as MTT and DNA fragmentation assays. The highly biologically amenable ND nanofilm was successfully integrated with therapeutic molecules, and the functionality of the composite drug-ND material was assessed via interrogation of the suppression of inflammatory cytokine release. Knockdown of lipopolysaccharide-mediated inflammation was observed through the potent attenuation of tumor necrosis factor-alpha, interleukin-6, and inducible nitric oxide synthase levels following ND nanofilm interfacing with RAW 264.7 murine macrophages. Furthermore, basal cytokine secretion levels were assessed to examine innate material biocompability, revealing unchanged cellular inflammatory responses which strongly supported the relevance of the NDs as effective treatment platforms for nanoscale medicine. In addition to the easy preparation, robustness, and fine controllability of the film structures, these hybrid materials possess enormous potential for biomedical applications such as localized drug delivery and anti-inflammatory implant coatings and devices, as demonstrated in vitro in this work.

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The advent of therapeutic functionalized implant coatings has significantly impacted the medical device field by enabling prolonged device functionality for enhanced patient treatment. Incorporation of drug release from a stable, biocompatible surface is instrumental in decreasing systemic application of toxic therapeutics and increasing the lifespan of implants by the incorporation of antibiotics and anti-inflammatories. In this study, we have developed a parylene C-based device for controlled release of Doxorubicin, an anti-cancer chemotherapy and definitive read-out for preserved drug functionality, and further characterized the parylene deposition condition-dependent tunability of drug release. Drug release is controlled by the deposition of a layer of 20-200 nm thick parylene over the drug layer. This places a porous layer above the Doxorubicin, limiting drug elution based on drug accessibility to solvent and the solvent used. An increase in the thickness of the porous top layer prolongs the elution of active drug from the device from, in the conditions tested, the order of 10 min to the order of 2 d in water and from the order of 10 min to no elution in PBS. Thus, the controlled release of an anti-cancer therapeutic has been achieved via scalably fabricated, parylene C-encapsulated drug delivery devices.

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Amphiphilic block copolymers are finding increased potential in biological and medical research due to their innate alternating hydrophilic and hydrophilic blocks/segments which can be used to package therapeutics, or coat a broad array of biological interfaces. Some studies are already directed towards utilizing these copolymers' ability to form micelles or vesicles to develop novel methods of drug delivery to prevent inflammation or pro-cancer activity. Our study, however, aims to investigate the more fundamental cell-block copolymer interaction for use in protective nanofilms to prevent bio-fouling of non-tissue based implantable devices. Block copolymers could potentially fill the demand for biologically inert, highly functionalizable biomaterials desirable for this type of application. Two such polymers used in our study include PMOXA-PDMS-PMOXA triblock copolymer and PEO/PMMA diblock copolymer. Each block copolymer possesses hydrophilic and hydrophobic blocks that enable it to mimic the cell lipid membrane. So far we have shown that triblock copolymer is capable of inhibiting the accumulation of murine macrophages onto glass substrates. Preliminary evidence has suggested that the triblock copolymer has anti-adsorptive as well as non-inflammatory capabilities during short incubation periods (7 days) in vitro. While the diblock copolymer displays minimal anti-adsorptive activities, nanofilms comprised of a mixture of the two copolymers were able to significantly reduce macrophage accumulation onto glass substrates. The disparate behavior seen by macrophages on the different materials may be due to specific inherent properties such as preference for hydrophobic vs. hydrophilic surfaces and/or rough vs. smooth nano-textures. Furthermore, the specific end groups of the two polymers may exhibit varying capacities to resisting non-specific protein adsorption. Continued investigation outlining the physical and chemical properties desirable for an anti-adsorptive nano-film coating will serve as a basis upon which to design durable implant-tissue interfaces that can react to various external stimuli.

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The realization of optimized therapeutic delivery is impaired by the challenge of localized drug activity and by the dangers of systemic cytotoxicity which often contribute to patient treatment complications. Here we demonstrate the block copolymer-mediated deposition and release of multiple therapeutics which include an LXRα/ß agonist 3-((4-methoxyphenyl)amino)-4-phenyl-1-(phenylmethyl)-1H-pyrrole-2,5-dione (LXRa) and doxorubicin hydrochloride (Dox) at the air-water interface via Langmuir-Blodgett deposition, as well as copolymer-mediated potent drug elution toward the Raw 264.7 murine macrophage cell line. The resultant copolymer-therapeutic hybrid serves as a localized platform that can be functionalized with virtually any drug due to the integrated hydrophilic and hydrophobic components of the polymer structure. In addition, the sequestering function of the copolymer to anchor the drugs to implant surfaces can enhance delivery specificity when compared to systemic drug administration. Confirmation of drug functionality was confirmed via suppression of the interleukin 6 (Il-6) and tumor necrosis factor alpha (TNFα) inflammatory cytokines (LXRa), as well as DNA fragmentation analysis (Dox). Furthermore, the fragmentation assays and gene expression analysis demonstrated the innate biocompatibility of the copolymeric material at the gene expression level via the confirmed absence of material-induced apoptosis and a lack of inflammatory gene expression. This modality enables layer-by-layer control of agonist and chemotherapeutic functionalization at the nanoscale for the localization of drug dosage, while simultaneously utilizing the copolymer platform as an anchoring mechanism for drug sequestering, all with an innate material thickness of 4 nm per layer, which is orders of magnitude thinner than existing commercial technologies. Furthermore, these studies comprehensively confirmed the potential translational applicability of copolymeric nanomaterials as localized multitherapeutic thin film platforms.

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The advent of medically-relevant technologies forged at the interface of life science and engineering will undoubtedly play a major role in shaping the next-generation of experimental as well as clinical medicine. This review will explore the development of a suite of platform modalities that can be employed towards medical diagnostics and therapeutics. Their specific relevance and impact towards cardiovascular medicine will be realized through biotic-abiotic coalescence, or the bridging of biological materials such as cells and proteins with non-biological materials such as polymers or solid-state devices. These modalities include: (1) Real-Time Cellular Interrogation Technology, which enables real-time investigation, or examination of cellular signal transduction and gene expression as a response to environmental conditions; (2) Diagnostic Devices, which include the fabrication of micro/nano sensors for the targeting of molecules indicative of cellular disorders; and (3) Therapeutics, or the engineering of membrane mimetics, or biomolecule-functionalized thin films as strategies for synthetic biological regenerative medicine, as well as therapeutically-active polymers as biocompatible coatings for implants, to name a few. These approaches collectively represent a universally-applicable, and comprehensive diagnostic-treatment strategy whereby cardiovascular disorders, or medical diseases in general can be diagnosed, monitored, and fundamentally understood to unprecedented levels. In turn, these conditions can be therapeutically addressed using drug-releasing nanostructured polymers with minimal intrusion upon normal cellular behavior, or biologically-active hybrid membrane devices based upon the interface of proteins with robust biomimetic polymers.

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Nanodiamond materials can serve as highly versatile platforms for the controlled functionalization and delivery of a wide spectrum of therapeutic elements. In this work, doxorubicin hydrochloride (DOX), an apoptosis-inducing drug widely used in chemotherapy, was successfully applied toward the functionalization of nanodiamond materials (NDs, 2-8 nm) and introduced toward murine macrophages as well as human colorectal carcinoma cells with preserved efficacy. The adsorption of DOX onto the NDs and its reversible release were achieved by regulating Cl- ion concentration, and the NDs were found to be able to efficiently ferry the drug inside living cells. Comprehensive bioassays were performed to assess and confirm the innate biocompatibility of the NDs, via real-time quantitative polymerase chain reaction (RT-PCR), and electrophoretic DNA fragmentation as well as MTT analysis confirmed the functional apoptosis-inducing mechanisms driven by the DOX-functionalized NDs. We extended the applicability of the DOX-ND composites toward a translational context, where MTT assays were performed on the HT-29 colon cancer cell line to assess DOX-ND induced cell death and ND-mediated chemotherapeutic sequestering for potential slow/sustained released capabilities. These and other medically relevant capabilities enabled by the NDs forge its strong potential as a therapeutically significant nanomaterial.

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